Foreign Body Reaction to Hydrophilic Polymer Following Mohs Micrographic Surgery

The use of flow diverting stents for wide based, intracranial aneurysms has become an invaluable treatment option. While intracranial hemorrhage and ischemic stroke from dislodged atherosclerotic emboli are common adverse events, the potential for delayed granulomatous inflammation from possible hydrophilic polymer emboli is rarely recognized. We present a unique case in which visible chipping of the pusher wire for stent placement was observed, followed by clinical and radiographic evidence suggestive of a delayed foreign body reaction to intracranial hydrophilic polymer emboli. A 55-year-old woman underwent placement of a Pipeline embolization device for a left-sided, broad-based aneurysm at the base of the internal carotid artery and posterior communicating artery. Two months later she developed right-sided focal neurological deficits. Imaging showed ipsilateral focal edema and enhancing lesions with contrast. Although not confirmed with biopsy and histopathology, clinical and radiographic evidence suggests that this patient probably experienced a delayed foreign body reaction to hydrophilic polymer emboli from compromised procedural equipment during flow diverting stent placement. Although previously described, this is the first instance to our knowledge in whichvisible chipping of the pusher wire was observed on a Pipeline embolization device.

Download Full-text

Cerebral foreign body reaction after carotid aneurysm stenting

Interventional Neuroradiology ◽

10.1177/1591019915609171 ◽

2015 ◽

Vol 22 (1) ◽

pp. 53-57 ◽

Cited By ~ 21

Author(s):

Anastasia Orlova Lorentzen ◽

Terje Nome ◽

Søren Jacob Bakke ◽

David Scheie ◽

Vidar Stenset ◽

...

Keyword(s):

Foreign Body ◽

Internal Carotid ◽

Foreign Body Reaction ◽

Artery Aneurysm ◽

Brain Biopsy ◽

Flow Diverter ◽

Left Internal Carotid Artery ◽

Hydrophilic Polymer ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm

Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization – a multifocal inflammation spread out through the white matter of one hemisphere without hemorrhage or ischemic changes.

Download Full-text